HomeMy WebLinkAbout48808-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
r TOWN CLERK'S OFFICE
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit #: 48808 Date: 1/25/2023
Permission is hereby granted to:
LLC
Montauk .............................................................. ..._._
12 Roosevelt Ave Ste 2
.._. ._......... .. ...... _ .._.....___
Mystic. CT 06355
To: Demolish an existing single family dwelling and construct a new single family dwelling
as per SCHD approval. Fire Sprinkler System required as applied for. Additional
certification may be required.
At premises located at:
Montauk Ave., Fishers Island
SCTM # 473889
Sec/Block/Lot# 10.-7-25
Pursuant to application dated 12/13/2022 and approved by the Building Inspector..
To expire on _7/26/2024. m
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $1,832.80
CO -NEW DWELLING $50.00
DEMOLITION $342.30
Total: $2,225.10
.... ................ .. .....mm............ ....
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
� Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax(631) 765-9502 httL)s-//www.soLitholdtown .
Date Received
APPLICATION
For Office Use Only
PERMIT NO. 0 �� Building Inspctory 202
Applications and forms must be filled out in their entirety.Incomplete MAD"L)EK
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Dat;..----,&i- 12- , 20 2� Z
OWNER(S)OF PROPERTY:
1 I
Name: MOr1�L U -'�w 7�/c/o SCTM#1000- w _
Project Address:
a
Phone#: �e 9J`7 7 , b (N-1 Email: -/b/,/i) �v/dJ �c J" r (w
Mailing Address, Q
CONTACT PERSON:
Name:4J re C_ -t) I c.-1u
Mailing Address: P 0, i�o-C i l2q , hei� ��{Q�c/ ti V 0 316
Phone#:0, '�1,/-- 6 )/- Vo-- Email:
DESIGN PROFESSIONAL INFORMATION:
Name:-a . IJo
Mailing Address: Iu Ct , tbl/c ��d /"�� / AJ,4' // 7(., ,5_
Phone#: of- v, JO VU„ Email: ( �p C'e: Cry�-
CONTRACTOR INFORMATION:
Name: �-
Mailing Address:
Phone#: ou,317.Ca . Email: • kl, /40 , cC/14,--
DES�RIPTION OF PROPOSED CONSTRUCTION
New Structure ❑Addition ❑Alteration ❑repairI.�emolition Estimated Cost of Project;.
❑Other $
Will the lot be re-graded? [ Yes El No Will excess fill be removed from premises? ❑Yes ` -Pao
144 10
1
PROPERTY INFORMATION
Existing use of property: 1 . � Intended use of property: ,
Zone or use district In which premises is situated: Are there any covenantsAnd restrictions with resile to
_4 o this property? ❑Yes Eo IF YES, PROVIDE A COPY.
❑ Check Box After reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the Issuance of a Building Permit pursuant to the Building Zone
Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings,
additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,
housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By(print name): `,49Z� w )j� ❑Authorized Agent Owner
Signature of Applicant: Date: 2 -1Z-2,_2
STATE OF NEW YORK)
SS:
COUNTY OF Z
:JA W 2a[,_0 6) being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the G
(Contractor,Agent,Corporate Officer,etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application;that all statements contained in this application are true to the best of h is/liefknow ledge and belief; and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
_4j�qay of �&iia&a . 20ZZ
� otary Public41pe
� IER"ry OVYINER AUrtiORIZATION
(Where the applicant is not the owner)
I, residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2